The impact of HIV/AIDS stigma on HIV counseling and testing in a high HIV prevalence population in Uganda.

BACKGROUND: Despite its importance in HIV/AIDS prevention and treatment, HIV/AIDS Counseling and Testing (HCT) is low in sub-Saharan Africa, where the disease continues to be a serious public health problem. This has in part been attributed to HIV/AIDS related stigma. OBJECTIVE: To assess the level of HIV/AIDS related stigma and its impact on uptake of HCT in a high HIV prevalence population in Uganda. METHODS: The paper used cross-sectional data on 135 men and 185 women in reproductive ages. Data were analyzed using the Pearson's chi-square statistic and the random intercept binary logistic regression model to identify significant predictors of uptake of HCT. RESULTS: The result shows that only 18.4% of the respondents, most of them men expressed highly stigmatizing attitudes against PLHA and 59%, men and women alike, received HCT. Uptake of HCT was higher among men (OR=1.89, p<0.01) and women (OR=4.48, p <0.001) who expressed least stigmatizing attitudes. Secondary/higher education, work in the informal sector and being ever married were significant predictors of uptake of HCT. Compared to men, women aged 25-34, 35+ and with one sexual partner were more likely to have received HCT. CONCLUSIONS: The low level of stigma, older age, higher level of education, being ever married and monogamous sexual relationships are significant predictors of increased uptake of HCT.

Impact of male circumcision on HIV risk compensation through the impediment of condom use in Botswana.

BACKGROUND: Male circumcision has been recommended as a method of reducing the risk of transmitting HIV. However, widespread uptake of male circumcision may lead to HIV risk compensation by impeding condom use. OBJECTIVE: To investigate the impact of male circumcision on condom use. METHODS: The study used cross-sectional data from the Botswana AIDS Impact Survey III on 1,257 men aged 15 years or older who were sexually active. Data were analyzed using Pearson's chi-square statistic and binary logistic regression. RESULTS: The study found that 15% of circumcised men did not use condoms compared to 12% of uncircumcised men, and circumcision was not significantly associated with condom use. Non-use of condoms was significantly affected by religious beliefs, low level of education, marriage, drunkenness, and misconceptions regarding antiretroviral therapy (ART). CONCLUSIONS: We conclude that male circumcision does not impede condom use. Condom use is impeded by low level of education, marriage, drunkenness, and misconceptions regarding ART. We recommend the emphasis of consistent condom use targeting people with low education, those in marriage, users of alcohol, and people receiving ART.

Village-based AIDS prevention in a rural district in Uganda.

OBJECTIVE: To design, implement and evaluate a village-based AIDS prevention programme in a rural district in north-western Uganda. A baseline KAP survey of the general population was carried out to design a district-wide information campaign and condom promotion programme. Eighteen months later the impact achieved was measured through a second KAP survey, using the same methodology. METHODS: Anonymous structured interviews were conducted in March 1991 and October 1992 with 1486 and 1744 randomly selected individuals age 15-49, respectively. RESULTS: At 18 months, 60% of respondents had participated in an information session in the past year (47% women, 71% men) and 42% had received a pamphlet about AIDS (26% women, 58% men). Knowledge about AIDS, high initially (94%), reached 98%. More respondents knew that the incubation period is longer than one year (from 29% to 40%), and were willing to take care of a PWA (from 60% to 77%). Knowledge about condoms increased from 26 to 63% in women and 57 to 91% in men. Ever use of condoms among persons having engaged in casual sex in the past year increased from 6 to 33% in women, and 27 to 48% in men. Fifty per cent of condom users criticized lack of regular access to condoms. CONCLUSIONS: This is the first documented example of the impact a village-based AIDS prevention programme can achieve in a rural African community. Critical areas to be improved were identified, such as: women must be given better access to information, more attention must be paid to explain the asymptomatic state of HIV infection in appropriate terms, and condom social marketing must be developed.

PIP: A population-based knowledge, attitude and practice (KAP) survey was carried out as the first step in designing and implementing an AIDS prevention program. The design and implementation of an AIDS information campaign and condom promotion program following the results of the first KAP survey is described. Anonymous interviews on knowledge, attitudes, and practices related to AIDS were conducted in February-March 1991 on a representative sample of the adult population of the district. A 3-stage cluster sampling procedure (parish, village, household) was applied to 800 randomly selected households. In each household 1 man and 1 woman in the 15-49 age range were randomly selected and interviewed. A total of 1486 interviews (753 women, 733 men) were completed. More than 90% of respondents had heard of AIDS, and of these 90% knew that the disease is sexually transmitted and not curable. During September 1991-January 1992 of the information campaign, an estimated 50,000 people attended the village-based information sessions, and 45,000 pamphlets and 40,000 condoms were distributed. A second KAP survey was carried out during September-October 1992 to evaluate the impact of the AIDS prevention program. A total of 1744 questionnaires (874 women, 870 men) were completed and analyzed. Knowledge about the prevention of AIDS had improved substantially, from 40% to almost 70% of the respondents. Overall 39% of respondents knew that the time between infection and disease is more than one year, as compared to 26% at baseline. The proportion of respondents willing to take care of a family member suffering from AIDS had increased from 60% to 77% (p 0.001) between 1991 and 1992. In addition, the proportion of respondents who had ever used condoms increased from 23% to 46% among those who had engaged in casual sex in the past year. However, the overall proportion of respondents who had ever used a condom had remained at 3%. About half of the condom users complained about lack of access to condoms.

Has AIDS awareness changed sexual behaviour in Uganda?

This chapter reports on a study of sexual behavior in three districts of Uganda. The fondings reveal almost universal knowledge about AIDS and its causes. More than two-thirds of the respondents considered themselves to be at risk of HIV infection and a substantial percentage of respondents were aware of measures to prevent infection. Some behavioural changes among respondents were noted as a result of AIDS. The majority of the respondents preferred confining sexual relations to one partner and expressed a willngness to udnertake HIV tests. Most respondents said they would live responsibly with the disease and would not have sex if sexual partners refused to use condoms. Condom use was low (36.7) with the majority of users wanting to avoid Acquired Immunodeficiency Syndromes and AIDS. A positive relationship between awareness and sexual behavior was observed